鼻咽癌放疗后与30天非计划再入院（血液学毒性相关）相关的出院前血细胞计数和营养风险标志物模式：一项多中心队列研究。
Predischarge blood count and nutritional risk marker patterns associated with 30-day unplanned readmissions for hematological toxicity after radiotherapy for nasopharyngeal carcinoma: a multicenter cohort study.
文献信息
| PMID | 42952952 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Guifei Zhou |
| 作者单位 | School of Nursing, Youjiang Medical University for Nationalities, Baise, Guangxi, China. |
| 期刊 | Frontiers in medicine |
| SCI 分区 | Q1 |
| IF | 3.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 以放疗为基础的治疗后早期非计划再入院可能反映残留毒性及支持治疗协调方面的不足。我们探讨了出院前血液学和白蛋白标志物模式与鼻咽癌（NPC）患者30天血液学毒性相关非计划再入院之间的关联。
方法： 这项多中心回顾性队列研究纳入2018年12月至2026年3月期间在中国西南地区三家三级医院因以放疗为基础的治疗住院后出院的607例患者。主要完整病例样本包括588例具有出院前中性粒细胞绝对计数（ANC）、血小板计数（PLT）和白蛋白测定值的患者。核心标志物为ANC <1.5 × 10⁹/L、PLT <200 × 10⁹/L和白蛋白 <35 g/L。我们采用关联规则挖掘和Firth惩罚logistic回归。在敏感性分析中考察了化疗和支持治疗变量，全因30天非计划再入院作为支持性次要结局。
结果： 根据30天内按时间顺序的首次再入院，607例患者中有77例（12.7%）被归类为非计划再入院；77例中有58例（75.3%）被归类为血液学毒性相关。在主要样本中，零个、一个和两个及以上核心标志物的血液学再入院率分别为4.9%、13.1%和17.5%。与零个标志物相比，一个和两个及以上标志物的校正比值比（OR）分别为2.86 [95%置信区间（CI）1.50-5.46]和4.33（95% CI 1.82-10.30）。化疗校正后相应OR为2.93和4.55，支持治疗校正后为2.59和3.47。全因分析显示相似梯度（OR 2.65，95% CI 1.52-4.61；OR 3.18，95% CI 1.43-7.05）。
结论： 常规出院前指标与早期再入院风险相关，但研究结果并未确立因果关系或临床决策规则。在临床使用前需要进行前瞻性外部验证。
英文摘要
BACKGROUND: Early unplanned readmissions after radiotherapy-based treatment may reflect residual toxicity and gaps in supportive care coordination. We examined associations between predischarge hematological and albumin marker patterns and 30-day hematological toxicity-related unplanned readmission in nasopharyngeal carcinoma (NPC).
METHODS: This multicenter retrospective cohort study included 607 patients discharged after hospitalization involving radiotherapy-based treatment at three tertiary hospitals in southwestern China between December 2018 and March 2026. The primary complete-case sample comprised 588 patients with predischarge absolute neutrophil count (ANC), platelet count (PLT), and albumin measurements. Core markers were ANC <1.5 × 10⁹/L, PLT <200 × 10⁹/L, and albumin <35 g/L. We used association rule mining and Firth penalized logistic regression. Chemotherapy and supportive care variables were examined in sensitivity analyses, and all-cause 30-day unplanned readmission was a supportive secondary outcome.
RESULTS: Based on the chronologically first readmission within 30 days, 77 of 607 patients (12.7%) were classified as having an unplanned readmission; 58 of the 77 (75.3%) were classified as hematological toxicity-related. In the primary sample, hematological readmission rates were 4.9%, 13.1%, and 17.5% for zero, one, and two or more core markers, respectively. Adjusted odds ratios (ORs) were 2.86 [95% confidence interval (CI) 1.50-5.46] and 4.33 (95% CI 1.82-10.30) for one and two or more markers versus zero markers. Corresponding ORs were 2.93 and 4.55 after chemotherapy adjustment and 2.59 and 3.47 after supportive care adjustment. The all-cause analysis showed a similar gradient (OR 2.65, 95% CI 1.52-4.61; OR 3.18, 95% CI 1.43-7.05).
CONCLUSION: Routine predischarge measures were associated with early readmission risk, but the findings do not establish causality or a clinical decision rule. Prospective external validation is required before clinical use.